Aetna Releases New Deadlines for Case Submissions

New deadlines for case submissions effective February 1

Sales notification/CIR for electronic case submissions are due by the 22nd of the month with complete electronic case submission by the 27th of the month prior to the requested effective date. This applies to Small Group AFA new business and current customers moving to AFA at renewal.

Opioid Use Disorder: An Epidemic That Does Not Discriminate

Jennifer Agnello

Jennifer Agnello | President

Recently I attended a seminar on what has become the nation’s number one health care crisis: opioid use. It was a wake-up call to some astonishing information. Our industry has begun to feel the devastating effects and so far there is no end in sight. The statistics were alarming:

  • Every 16 minutes, there is a death from opioid overdose
  • 1,375 percent increase in opioid treatment spending over five years
  • 4.5 million Americans estimated to have a substance use disorder associated with prescription painkillers
  • $78.5 billion estimated cost of America’s opioid epidemic

According to Center for Disease Control and Prevention mortality data, death rates for young adults ages 25 to 44 has increased from 139.8 per 100,000 in 2010 to 151.3 per 100,000 in 2015, an increase of 8.2 percent in 5 years. In our own backyard (Ohio, Kentucky, Indiana, West Virginia, and Pennsylvania), those increases were 20 percent or more. This is concerning data when you factor in the costs associated and the number of lives destroyed.

In 2016, it is estimated that 59,000 to 65,000 lives were taken from drug overdoses in the U.S. These estimates are conservative, considering unreported or misreported overdose deaths. Compare that with peak car crash death rates in 1972 of 54,589 and peak H.I.V. deaths in 1995 of 50,887.

As opioid use continues to rise, drug overdoses are expected to be the leading cause of death in the U.S. for Americans under age 50. Synthetic opioids, such as Fentanyl and its closely related counterparts, play a major role in driving overdose death numbers to exponential levels. Resources and budgets are strained by the rise in numbers. Increased police, medical care, foster care, and additional administrative burdens have all combined to quickly exceed state and federal budgets.

Many may ask how we arrived at such outrageous numbers. Some thought-provoking background:

From the mid-1980s through the 2000s

  1. First publication suggesting safety of extended opioid use in non-cancer pain
  2. MS Contin approval
  3. OxyContin approval
  4. APS launches “Pain as the Fifth Vital Sign” campaign
  5. Purdue launches $200 million marketing campaign
  6. Multiple new opioid brands and key generics flood market
  7. Opioid Rx volume and death toll skyrocket
  8. Government investigations ensue
  9. Purdue pays $600 million in fines for false promotion
  10. 2012: 259 million opiate Rxs were issued in the U.S.

The opioid use disorder (OUD) epidemic has been driven by the U.S. health care system’s unintentional widespread prescribing of opioid painkillers without realizing the consequences.

  • 80 percent of the world’s supply of all Rx opioids are consumed in the U.S.
  • 92 units is the average number of tablets per Rx. Opioid dependence can start in just a few days. Risk of chronic opioid use increases with each additional day of opioid supplied starting with the third day.
  • 91 percent of patients who experience opioid overdose receive another opioid Rx within 10 months.
  • 80 percent of heroin users report starting on Rx opioids prior to transitioning to heroin.
  • 53 percent of users received opioids free from a friend/relative, while another 16.6 percent took or bought them from a friend/relative.

The CDC publishes guidelines for prescribing opioids which include, but are not limited to:

  • Opioids are not to be the first line therapy for chronic pain.
  • Short duration of acute pain.
  • Three days of therapy should be sufficient, more than seven days is rarely needed.
  • The lowest effective dose is recommended to start.

Interestingly, 44.7 percent of first-fill opioid prescriptions are NOT in compliance with CDC recommendations.

From an insurer’s perspective, the focus is on methods of treatment and the education of providers. Determining the most effective approach to care in order to provide sustained long-term results is critical. Approaching OUD as a long-term chronic condition, instead of relying solely on short-term interventions, is essential. Each patient is unique and needs dedicated appropriate resources and guidance.

Pairing counseling and cognitive behavioral therapy with approved FDA medication to treat substance abuse disorders and prevent opioid overdose are more effective than behavioral interventions or medication alone. Studies suggest that with this medication-assisted treatment, the chances of remission within a year are significantly greater, up to 50 percent compared to 10 percent with traditional treatment. Along with these figures, this type of treatment costs up to 75 percent less than residential treatment. Education of physicians for this treatment protocol is critical and will take time. However, insurance carriers are responding to the needs rapidly and are developing methods to educate both the providers and the public.

In March of 2017, President Trump created a commission to study the crisis and their interim report has made a number of initial recommendations. As of October 2017, the Trump administration declared the opioid crisis a public health emergency.

As we, together, begin to recognize the scale of this crisis, it is critical that we acknowledge that OUD is an epidemic that does not discriminate. Be it the athlete who is prescribed pain medications for an injury and becomes addicted, or a relative who is recovering from surgery, or any one of the many circumstances in which victims lives are taken, let’s not be so quick to judge. Taking a “moral” perspective will not effect change. Instead, we need to come together to find a solution.

Anthem To Decrease Paper Clutter With “Welcome” Communications

Anthem is working to decrease paper clutter with changes to their “Welcome” communications to the Large Group market in 2018. The company will also start converting eligible members to electronic Explanation of Benefits (EOBs) and legally required information. The goal with eliminating the paper trail and moving to digital is to ensure more timely and updated information.

Click here to read more.

 

Aetna Deadlines for the End of AEP Enrollments

Aetna Medicare AEP marketing efforts must cease on December 7, 2017 (at the end of AEP). See below for more important dates:

December 7, 2017. All AEP applications for January 1, 2018, effective date must be completed, signed, dated, and received by the agent no later than 11:59 p.m. December 7, 2017. You may not backdate the member signature date, agent receipt date, or agent signature date.

Submit apps within 2 daysAetna must receive signed enrollment applications within two calendar days after you receive them from beneficiaries.

December 9, 2017. Aetna must receive all applications by December 9 to process them for a January 1 effective date.

After AEPIf you receive a completed enrollment application after AEP ends on December 7, do not hold or destroy it. Under CMS rules, you must still submit it to us within two calendar days as noted above. Aetna then will process or deny the enrollment as appropriate.

Reminders About MMO Products Before AEP Ends

See below for a few last minute reminders from MMO as AEP comes to an end.

Competitive Advantage Medicare Advantage:

  • Broad service offering representing 80 of the 88 counties.
  • Many of the common medications are in the MMO MA formulary.
  • Drugs that typically fall in Tiers 3, 4, or 5 with other carriers are Tier 1 and 2 with MMO.
  • Very low maximum out-of-pocket
  • Comprehensive network of facilities and doctors spanning across the state of Ohio. Ability to go to any in-network doctor or hospital regardless of where a member is domiciled.
  • $0 HMO Classic available in Region 1 counties.
  • No referrals or Gatekeepers required.
  • Earn an additional $50 per member.

 

Competitive Advantage Medicare Supplements:

  • Low renewals trending over the last 5 to 7 years with some decreases that have occurred.
  • Competitive rates across all age bands across the entire state of Ohio.
  • One preferred rate for a potential applicant, no male/female, smoker/non-smoker, regional, or other factors when determining a rate.

Contact your Cornerstone representative for more information about MMO products.

How to Prep for After the Enrollment Season

You spent months prepping yourself and your clients for the enrollment season. But do you have a game plan for when it’s all over?

Thank your clients for their business. Ready your portfolio with a stack of “Thank You” cards that will be handwritten and sent out to both loyal and new clients. A simple, thoughtful message expressing your gratitude for their business is a great way to cultivate new professional relationships and ensure long-lasting rapport.

Keep open communication with your clients. After the enrollment season, it’s still important to maintain contact with your clients to ensure that they are happy with their coverage. Consider adding newsletters to your marketing portfolio with health tips, coverage options, basic health care education, industry news, etc.

Evaluate your brand. What marketing tactics worked during this enrollment season? Was your website effectively drawing in prospective clients? Are you happy with your branding? Post-enrollment is the best time to take a look at your brand and make changes that will positively impact the offseason and your next busy season. Create a consistent brand that your clients can trust. Click here to enhance your brand with new marketing pieces.

 

Retention is just as important and prospecting. Put your focus on maintaining your client base after this enrollment season.

5 Tips For Managing Stress This Enrollment Season

The enrollment season is the busiest, and most stressful, time of the year. It’s easy to get caught up in your inbox, your voicemails, paperwork, and more, especially with deadlines looming closer. However, in order to properly take care of your clients and stay on top of a heavy workload, it’s important to manage your stress.

Keep yourself mentally and physically at the top of your game by following any of the stress management tips below:

  1. Recognize signs of stress and your stressors. Does tackling the mountain of papers on your desk feel like an inconceivable task? Is your desk too disorganized to focus on much else? Are you lacking the tools necessary to help you through the busy season? Take a minute to identify and tackle your stressors so you can learn how to properly manage them.
  2. Set your major priorities at the beginning of the day, leaving room for emergencies. It’s difficult to avoid multitasking with a heavy workload. You find yourself answering emails while trying to accomplish 50 other tasks at the same time. At the beginning of the day, set between 3–5 priorities that you need to accomplish, be it a call to a client, answering an important email, focusing on marketing, etc. But be sure to leave some room for emergencies that may pop up throughout the day. Priorities will sometimes shift, so you want to prepare yourself to manage new priorities as they come along.
  3. Don’t be afraid to take a break. An article from The Atlantic stressed the importance of walking away from your desk throughout the day. The article referenced a study by the DeskTime productivity app which concluded that higher performer workers in the study would work for an average of 52 minutes, followed by a 17-minute break, often away from the computer. This means taking a short walk around the office, speaking with a coworker, stretching, getting a cup of coffee, etc.
  4. Take care of yourself. Get rid of that 3 pm fatigue! Even on your busiest days, be sure that you are eating the proper amount of nutrient-dense foods, focus on gaining as much rest as possible, and remain active. When your body is at its peak, it will run more efficiently to get the job done.
  5. Use the resources and materials available to you. Cornerstone has a number of online resources that are specifically designed to streamline and maximize the efficiency of your business. Check these out here.

ATTENTION OHIO BROKERS: Anthem’s Medicare Supplement Bonus Program for 2018!

Great News for Brokers in Ohio!

The more you sell, the more you earn with Anthem’s Medicare Supplement Sales Bonus Program!

Now YOU have a new opportunity to earn even more on EVERY Medicare Supplement Plan you SELL!

New, short-term incentives have just been announced for brokers who sell Anthem’s Medicare Supplement plans! Don’t miss out on this limited time opportunity to earn more when you sell Anthem Blue Cross and Blue Shield Medicare Supplement plans with 1/1/2018 effective dates!*

 

How Does it Work? 

  • If you sell 3 approved Medicare Supplement policies you’ll receive an additional $100 bonus per sale!
  • But if you sell 5 or more approved Medicare Supplement policies you’ll receive an additional $150 bonus per sale!

EXAMPLE:  If you sell 3 Medicare Supplement policy in a month with a qualifying effective date of 1/1/2018 you’ll earn a $300 bonus (3× $100)! But if you sell 5 plan policies, you’ll earn $750 (5× $150)!

 

Program Rules:

  • All per sale bonus amounts are in addition to the standard broker compensation.

 

Your current and prospective clients can benefit from these money-saving options on every Anthem plan:

  • A 5% discount on each policy if there is more than one Medicare Supplement policy written in a household with a coverage date of June 1,2010 or after.
  • Receive $2 off their monthly premium simply by enrolling in automatic electronic premium payments—a savings of $24 annually. Save $48 by paying their premium for the entire year.
  • There’s even greater savings for your clients when you help them combine discounts (based on eligibility).

 

While your clients are saving money, they can also stay healthy by taking advantage of the SilverSneakers Fitness Program, which offers eligible Modernized Anthem Medicare Supplement members a Basic Membership with access to over 13,000 locations nationwide—at no extra cost!**

So don’t wait!  It’s time to take advantage of this limited time opportunity to make more money selling Anthem Blue Cross and Blue Shield Medicare Supplement Plans!

 

Questions? Contact your Cornerstone representative today.


* Incentive is limited to new enrollees only-and based upon approval of the policy. All incentives will be paid within ninety days of the end of the bonus period. Anthem reserves the right to make all rules and determinations regarding the bonus program, and may modify or eliminate the program at any time without notice.  For more detailed information on the bonus program, please contact your Regional Sales Manager.

**SilverSneakers is a value-added program. It is not insurance and not part of the Medicare Supplement insurance plans. It can be changed or withdrawn at any time.

 

Individual Market Referral Program Update

Close-up of female and male handshaking over workplace with business documents

On November 2, 2017, Cornerstone released an email relaying Medical Mutual’s decision to manage all MMO sales and service support for their in-force Individual policies starting on January 1, 2018. This decision includes MMO policies with a January 1, 2018, effective date.

In response to several inquiries regarding this update, Cornerstone would like to confirm that this change does not, in any way, affect our referral program. We continue to accept individual referrals and will quote and process enrollments with products available from all our carrier partners, including Medical Mutual.

It is an extremely busy time of the year and we are available to provide you with the help and support you need. Please don’t hesitate to reach out to your Cornerstone representative with any questions you may have.


About Cornerstone’s Referral Program

Not looking to write Individual business? Refer your clients to Cornerstone where our experts will provide a service and resource platform that ensures they receive the proper support for all things benefit related. Plus, receive lifetime commissions for as long as the member is in force.

 

Contact your local Cornerstone representative for more information about this very beneficial program.

Exploring ACA Alternatives

Gregg Amato

Gregg Amato | Director of Employee Benefits (Cleveland)

Since the inception of the Affordable Care Act (ACA), many small group employers and brokers alike have experienced constant change and confusion. Premiums continue to rise and many feel there are limited options available to them. Small groups with fewer than 50 employers are not mandated to provide health insurance, but many would like to offer it as a way to fill full-time positions and attract talented employees. Before health care reform, health insurers were allowed to rate up or charge higher premiums to small groups based on their medical history, age, and gender. This made it difficult for unhealthy groups to find affordable coverage.

Healthcare.gov defines community rating as: “A rule that prevents health insurers from varying premiums without a geographic area based on age, gender, health status, or other factors.” Community rating means that all enrollees pay the same premium amount regardless of their health status. The cost is pooled or spread out over a large number of insured people. For groups with fewer than 50 employees, ACA community rating benefitted some and hurt others. Small groups with multiple health conditions or an aging population benefitted from lower rates, while younger healthier groups pay more.

Under ACA guidelines, the “Adjusted Community Rating” methodology is being used. Health insurers aren’t allowed to charge higher premiums based on health conditions, medical claims, or gender. However, they are allowed to charge higher premiums based on the number of employees enrolled in the plan and where the group is located within areas that have higher costs of care. Insurers can consider an employee’s age and whether they use tobacco products. The age ratio of 3:1 means that an older adult cannot be charged more than three times the rate of a younger adult. The tobacco ratio of 1.5:1 means that a person using tobacco cannot be charged more than 1.5 times the non-tobacco user rate.

The ACA’s Health Insurance Tax is due to return in 2018 and threatens to increase already high insurance premiums even more. According to America’s Health Insurance Plans (AHIP), “The health insurance tax (HIT) is a $100 billion+ tax on health coverage for individuals, small businesses, seniors, states, and tax payers. For example families in the small-employer market could see their premiums go up an additional $7,000 over the next 10 years because of this tax. AHIP will continue to push for a full repeal of the health insurance tax because it makes health care less affordable for the very people who need the most help affording health care.”

ACA-compliant plans are fully insured plans. All the risk is passed on to the insurance carrier. These small group plans offer a wide variety of plan designs that can benefit the small employer, however many factors continue to threaten additional premium hikes in the upcoming years. Small business owners are faced with controlling their costs. It’s not surprising that over half of small group employers do not offer health insurance coverage. As ACA premiums continue to rise, so does the need for ACA alternatives. When ACA plans arrived, small employers were allowed to keep their coverage with only minor changes to their plan or risked losing their transitional (grand-mothered status). Now, as these small group employers consider moving to ACA plans, some may see a premium reduction, while others will see significant increases. The employer groups that can’t find a reduction will stay on their transitional plans to avoid ACA as long as possible. However, with transitional plans soon to expire, employers need alternative options.

Level-Funding Options

Many of the health insurers have already provided alternatives to ACA plans and are currently available to small businesses. Historically, self-funding has been a viable option for large group employer with 100 or more employees. The introduction of level-funding has created an alternative for groups in the small group market. Level-funded plans are self-insured plans with predictable premiums and are available to groups down to 10 employees. These plans have a low specific attachment point. The healthier groups usually receive the more attractive rates since they are medically underwritten. Groups that select a level-funded product option will have level or fixed monthly premiums. To be considered for coverage, groups must be healthy and approved by the underwriters. Lower risk groups may pay premium rates lower than ACA rates, while higher risk groups will pay premium rates higher than ACA rates. Many of the small groups that qualify for level-funding options will not be familiar with the concept and will rely heavily on their broker for expertise.

Level-Funding Cost components:

  • Administrative Expenses
  • Stop loss (Specific and Aggregate)
  • Claims fund (paid by the level-funded entity). At the end of the coverage period, a shared savings opportunity exists for groups with claims surplus.

At renewal and if the group had a low claims year, there should be minimal rate increase. In a bad claims year, the employer never has to pay more than the level premium amount because the stop loss coverage protects them. However, they should expect to see a rate increase and now have the option of moving to a community-rated ACA plan if premium savings exists.

Multiple Employer Welfare Arrangements (MEWA)

A Multiple Employer Welfare Arrangement (MEWA) is another popular alternative to ACA plans. MEWAs were created several years ago and can benefit small groups down to two employees. They are a self-funded insurance plan where multiple employers pool their financial resources and share their risk. MEWAs are member-owned profits that stay within the group and can be dispersed among the member companies. Much like the level funding, employer groups must qualify medically.

Typically a board of trustees is formed to manage the MEWA, enabling greater flexibility in selecting plan designs and meeting the overall needs of the group. MEWAs can implement programs that promote wellness and can save overall claims costs of the group, which ultimately lower premiums. Since the group is in control within the MEWA, there is increased stability and lower tax rates for the member companies that don’t exist with fully insured plans.

Small group employers, along with their brokers, are facing a dilemma. Many employers want to offer coverage for their employees while attracting talented future employees. Premiums are on the rise and options were limited, but adversity breeds solutions. The insurance industry has answered and created alternatives for the small group market by providing level funding and MEWA plans.

Please contact your Cornerstone sales representative to learn more about our partner carriers that offer MEWA and level funded alternatives now available to your small group clients.